I, Antonio Bazzani, aged 42 years, occupation, laborer, do declare on oath that my personal description is: color white, complexion dark, height 5'6", weight 170 pounds, color of hair, black, color of eyes, brown other visible distinctive marks - none. I was born in Fanano, Italy on the 14th day of September 1883,, I now reside at 1342 Washington St, Gary, indiana. I emigrated to the U.S. of A. from Genoa, Italy on the vessel Saromina; my last foreign residence was Italy; I am married; the name of my wife is Carolina; she was born at Italy and now resides at Italy. It is my bona fide intention to renounce forever all allegiance and fidelity to any foreign prince, potenatate, state or sovereignty, and particularly to Victor Emmanuel III, King of Italy of whom I am now a subject; I arrived at the port of NY in the state of NY, on or above the 19th day of Oct. 1919; I am not an anarchist; I am not a polygamist nor a believer in the practice of polygamy; and it is my intention in good faith to become a citizen of the US of A and to permanently reside therein: SO HELP ME GOD.
(Signed) Bazzani Antonio